Provider Demographics
NPI:1598975815
Name:FOX, MARY CLAIRE (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLAIRE
Last Name:FOX
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 IRIS CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1505
Mailing Address - Country:US
Mailing Address - Phone:201-818-6682
Mailing Address - Fax:201-251-0950
Practice Address - Street 1:272 IRIS CT
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1505
Practice Address - Country:US
Practice Address - Phone:201-818-6682
Practice Address - Fax:201-251-0950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00327400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223399447OtherUNITED HEALTH CARE PIN
NJ244345OtherVALUE OPTIONS PIN
NJ0004532456OtherAETNA PIN
NJ223399447OtherQUALCARE, INC.
NJ2233994470OtherHORIZON
NJ1097448OtherCIGNA VENDOR #
NJ0001049624OtherMHN VENDOR #
NJ809245000OtherMAGELLAN BEH HEALTH